2 posts from February 2008

February 12, 2008

The Macy Foundation Conference Summary was a much discussed topic at the ACME meeting just held January 19-22 in Orlando, Florida. Prior to the meeting Murray Kopelow, MD, the Executive Director of the ACCME, sent the conference summary out to all accredited CME providers and many company officials with the following note:

On January 10, 2008, the Josiah Macy Jr. Foundation released this executive summary of their November 2007 ‘Conference Convened to Address Complex Issues Concerning Continuing Education.’ It is important that we read it and understand what many people perceive is not happening in accredited CME.In all of our upcoming presentations and interactions, the ACCME will be talking about CME as aBridge to Quality, and about what CME and the ACCME are already doing and what we can do about CME as a strategic asset to quality improvement in healthcare, CME as practice-based learning, and accreditation’s role in facilitating inter-professional education.

When asked directly at the ACME meeting, Dr. Kopelow responded that the summary was sent out only to show “what some segments of CME are saying about our industry” and “the summary was sent out to promote dialogue . ”

The report can be broken down into four areas:

Improving education methods

Elimination of commercial support for CE

Limiting the types of organizations that offer CE

Creation of a NIH institute to study CE

There are many good recommendations in this report which may lead to improvements in patient care. Many of the recommendations will require significant study and funding to implement while the report calls for an up to 60% reduction in CE funding without practical solutions to replace the lost funding.

The conference summary stated that the practice of CE is in ‘disarray’ and “bias is woven into the very fabric of CE”. These opinions are offered without references or evidence to show commercial bias by manufactures of drugs and devices.

The report fails to address the potential for other types of bias including academic, commercial (subscription services), governmental (VA, Medicare, SBIR Grants), journals, non profits including HMO’s, Trial Lawyer and George Soros Funding.

The report also recommends the elimination of all private CE providers with the exception of Point of Care, Multi Specialty Group Practices, Hospitals and Journals (the exception list accounts for every group invited to the meeting). The report of course called for an end of commerically supported CME in five years (Altruism rules).

It is interesting to note while we were debating this issue in Orlando, Susan Fletcher, MD, chairman of the Macy meeting was at the IOM committee on conflict of interest giving testimony on the summary (explains why the summary was released 9 months in advance of the report with no citations)

February 11, 2008

The conference summary was released nine months in advance of the actual report at least inpart to influence an upcoming Institute of Medicine (IOM) report (2009) and the meeting of the Committee on Conflict of Interest in Medical Research, Education and Practice. The next public meeting is scheduled for March 13-14th, 2008 in Washington DC (see attached IOM public Meeting Invitation).

The Institute of Medicine is an influential part of the National Academy of Sciences, which was charted by Congress in 1863 to advise the government on important scientific and technical questions.

One of the co-sponsors of the IOM committee on the conflict of interest is none other than the Josiah Macy Foundation. The makeup of the IOM committee contains 6 of 17 members (including the chairman) who have publicly stated strong pro-regulatory positions on faculty conflict of interest.

The IOM program has the appearance of being stacked against the pharmaceutical industry commercial support for CME. First, participants were sent only one outside article as part of the conference packet: Health industry practices that create conflict of interest: a health policy proposal for academic medical centers, Brennan, JAMA 2006. Second, Harvey V. Fineburg, MD, PhD, President of the IOM was a Macy conference participant and we have been told that IOM has rejected reasonable requests for presentations from academic views other than the Macy participants at the IOM meetings. Third, the IOM committee itself is closely aligned with the Association of Academic Medical Centers and has many common members. Fourth, many of the prominent members of the group are consistent critics of pharma industry involvement in medicine, including, David Blumenthal (Institute for Health Policy, Harvard), Jordan Cohen (President Emeritus AAMC), Catherine DeAngelis (Editor and Chief JAMA).

The Association of Academic Medical Centers Conflict of Interest Taskforce is now in final editing of their new recommendations on faculty conflict of interest. It includes many Macy participants and will probably be similarly biased against the industry involvement with academics .